Opioid Update 2018
CenCal Health Pharmacy Update
2018 Opioid Morphine Equivalent Dose (MED) Limit
CenCal Health and its Pharmacy Benefits Manager (MedImpact), are working together to communicate formulary changes to plan providers. With the approval of CenCal Health's Pharmacy & Therapeutics Committee and in coordination with MedImpact, CenCal Health has begun a Multiphase Implementation Plan to deter over-utilization of opioids, and update utilization management measures.
Effective 7/1/2018, CenCal Health will be implementing the following MED (Morphine Equivalent Dose) edits to help minimize the over utilization of opioids:
- MED (Morphine Equivalent Dose) >120mg
Soft-Edit at the pharmacy, can be overriden by the pharmacy
- MED (Morphine Equivalent Dose) >200mg
Hard-Stop at the Pharmacy, Prior Authorization would need to be submitted to justify the MED>200mg
In an effort to minimize disruption to members on Chronic Opioid Therapy, we are notifying providers of the MED limits that will be effective 7/1/2018. For providers with members over the future MED limit, please see the recommended actions below to ensure that there is no disruption in therapy.
Actions to Take:
- Assess patient and review diagnosis, treatment plan, and possible titration from medications and or willingness to obtain addiction treatment from the County Drug and Alcohol Services Program.
- Santa Barbara County: 1-888-868-1649
- San Luis Obispo County: 1-800-838-1381
2. If member's medical condition necessitates continuation of therapy above the 200mg MED, the following information must be submitted to obtain Prior Authorization, starting 7/1/2018:
- Diagnosis with medical justification
- Pain Assessment
- Urine Screening-Shows concordance with prescriptions
- Attempts made to titrate therapy
- Alternative treatment/therapies attempted
Please contact CenCal Health Pharmacy Services Department at (805) 562-1080 if you have any questions.
Synagis® RSV Season
Synagis® Pharmacy Update: RSV Season
CenCal Health would like to assist our members and providers in preparation for the upcoming RSV season. In conjunction with the Department of Health Care Services' Children's Medical Services Network, the Synagis® prophylaxis season will begin November 1, 2018, and run through March 31, 2019. Medical Request Forms (MRFs) will be accepted beginning October 1st for initial administration beginning November 1st to ensure that the infant's child/weight is current.
Synagis® is required to be ordered through our Specialty Pharmacy vendor, Diplomat Specialty Pharmacy. Order forms can be obtained through the CenCal Health website at: www.cencalhealth.org or by contacting Diplomat Specialty Pharmacy directly at (877) 319-6337. Please contact CenCal Health Pharmacy Services Department at (805) 562-1080 if you have questions or need any assistance.
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